Centre for Interdisciplinary Trauma Research

Permanent link for this collectionhttp://hdl.handle.net/10292/20054

The aim of the Centre for Interdisciplinary Trauma Research (CITR) is to support and conduct trauma research that contributes to the health and wellbeing of people living in Aotearoa New Zealand and contributes to the international understanding of trauma and health. [This collection is currently being developed.]

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Indigenous People’s Experiences and Expectations of Health Care Professionals When Accessing Care for Family Violence: A Qualitative Evidence Synthesis
(Sage, 2020-10-07) Fiolet, R; Cameron, J; Tarzia, L; Gallant, D; Hameed, M; Hooker, L; Koziol-McLain, Jane; Glover, K; Spangaro, J; Hegarty, K
Although many Indigenous peoples demonstrate resilience and strength despite the ongoing impact colonization has on their peoples, evidence suggests poor experiences and expectations of health care professionals and access to health care. Health care professionals play an essential role in responding to family violence (FV), yet there is a paucity of evidence detailing Indigenous people’s experiences and expectations of health care professionals in the context of FV. Using a meta-synthesis of qualitative studies, this article aims to address the following research question: What are Indigenous people’s experiences and expectations of health care professionals when experiencing FV? The inclusion criteria comprised a qualitative study design, Indigenous voices, and a focus on expectations and experiences of health care professionals when FV is experienced. Reviewers independently screened article abstracts, and the findings from included papers were subject to a thematic analysis. Six studies were included in the final meta-synthesis representing studies from Australia, the Americas, and New Zealand. Three themes were identified. Health care professionals need to center the Indigenous person in the care they provide and demonstrate cultural awareness of how history and culture influence an individual’s care requirements. Health care professionals also need to ensure they are connecting for trust with the Indigenous person, by slowly developing a rapport, yarning, and investing in the relationship. Finally, Indigenous peoples want their health care professional to work on strengthening safety from culturally inappropriate care, institutional control, and potential lack of confidentiality associated with tight-knit communities.
Validity of the ACTS Intimate Partner Violence Screen in Antenatal Care: A Cross Sectional Study
(BioMed Central, 2021-09-24) Hegarty, K; Spangaro, J; Kyei-Onanjiri, M; Valpied, J; Walsh, J; Chapman, J; Koziol-McLain, Jane
Background: Intimate partner violence (IPV) is a major public health problem with harmful consequences. In Australia, there is no national standard screening tool and screening practice is variable across states. The objectives of this study were to assess in the antenatal healthcare setting: i) the validity of a new IPV brief screening tool and ii) women’s preference for screening response format, screening frequency and comfort level. Methods: One thousand sixty-seven antenatal patients in a major metropolitan Victorian hospital in Australia completed a paper-based, self-administered survey. The survey included four screening items about whether they were Afraid/Controlled/Threatened/Slapped or physically hurt (ACTS) by a partner or ex-partner in the last 12 months; and the Composite Abuse Scale (reference standard). The ACTS screen was presented firstly with a binary yes/no response format and then with a five-point ordinal frequency format from ‘never’ (0) to ‘very frequently’ (4). The main outcome measures were test statistics of the four-item ACTS screening tool (sensitivity, specificity, predictive values, and area under the curve) against the reference standard and women’s screening preferences. Results: Twelve-month IPV prevalence varied depending on the ACTS response format with 8% (83) positive on ACTS yes/no format, 12.8% (133) positive on ACTS ordinal frequency format and 10.5% (108) on the reference Composite Abuse Scale. Overall, the ACTS screening tool demonstrated clinical utility for the ordinal frequency format (AUC, 0.80; 95% CI = 0.76 to 0.85) and the binary yes/no format (AUC, 0.74, 95% CI = 0.69 to 0.79). The frequency scale (66%) had greater sensitivity than the yes/no scale (51%). The positive and negative predictive values were 56 and 96% for the frequency scale and 68 and 95% for the yes/no scale. Specificity was high regardless of screening question response options. Half (53%) of the women categorised as abused preferred the yes/no scale. Around half of the women (48%, 472) thought health care providers should ask pregnant women about IPV at every visit. Conclusions: The four-item ACTS tool (using the frequency scale and a cut-off of one on any item) is recommended for written self-administered screening of women to identify those experiencing IPV to enable first-line response and follow-up.
A Quest for Quality Care: Exploration of a Model of Leadership Relationships, Work Engagement, and Patient Outcomes
(Wiley, 2020-10-12) Koziol-McLain, Jane; Teo, S; Parr, JM
AIM: To explore the effects of resonant leadership, leader exchange relationships and perceived organizational support on work engagement and patient outcomes. DESIGN: A cross-sectional survey design. METHODS: Data were collected in June and July 2016 from 252 nurses and clerical staff and institutional patient safety (falls rates) and patient satisfaction (Friends and Family Test) in New Zealand. Data were analysed with structural equation modelling (SEM). RESULTS: The final model was an excellent fit to the data (χ2 (22, N = 252) = 39.048, p = 0.014). Resonant leadership was significantly and positively associated with relationships at work, perception of unit care quality (β = 0.28, p < 0.001), reduced falls rates (β = -0.14, p < 0.05) and better patient satisfaction (β = -0.41, p < 0.001). A direct effect of resonant leadership was demonstrated on patient satisfaction (β = 0.20, p < 0.01). Perceived organization support (β = 0.40, p < 0.001) and leader-member exchange (β = 0.46, p < 0.001) were confirmed antecedents of work engagement. Work engagement was confirmed as an antecedent of nurse perception of unit care quality (β = 0.21, p < 0.001). Where social exchanges exist, work engagement mediates these. Three further mediated paths bypassed work engagement altogether. CONCLUSION: Existing literature investigating the drivers and impacts of work engagement predominantly focuses on staff outcomes rather than patient outcomes. The findings identify modifiable factors to improve staff experience, patient safety, and ultimately patient satisfaction. Resonant leadership, a relational style, is a core antecedent of quality care and positively associated with staff experience and patient outcomes. IMPACT: This investigation into a real-world problem for nurse leaders also confirmed that an organizational focus on work engagement is not always required. Resonant leadership improves staff work experience, patient safety, and patient satisfaction. Nurse leaders should measure, foster, and develop resonant leadership in practice.
Health Response to Family Violence: Violence Intervention Programme Evaluation 2020-2024
(Centre for Interdisciplinary Trauma Research, Auckland University of Technology, 2025-11-11) Koziol-McLain, Jane; Herbert, Sarah; Garrett, Nick; Lowe, Kathy; Ngawati, Sarah; Pukepuke, Tepora
From the Executive Summary: This national evaluation report presents findings from the Violence Intervention Programme (VIP) across Aotearoa New Zealand’s health system from 2020 to 2024. The evaluation draws on qualitative interviews, infrastructure audits, site visits, and clinical audit data to assess the health sector’s response to intimate partner violence against women and child abuse and neglect for children under two years of age, with a particular focus on equity for Māori. Violence Intervention Programme Evaluation Dashboard
Health Response to Family Violence: 2019 Violence Intervention Programme Evaluation
(Centre for Interdisciplinary Trauma Research, Auckland University of Technology, 2020) Koziol-McLain, Jane; Gear, Claire; Henry, N; Garrett, N; Wilson, D; Janicot, S
Protecting Children in Aotearoa New Zealand: A Review on Legal and Professional Frameworks for Oral Health Practitioners
(Informa UK Limited, 2024-12) Han, Heuiwon; Koziol-McLain, Jane; Diesfeld, Kate; Carrington, Samuel D; Morse, Zac; Lees, Amanda B
The United Nations Convention on the Rights of the Child asserts that all children have the right to protection from abuse and exploitation. In Aotearoa New Zealand, the prevalence of child maltreatment requires vigilant action from oral health practitioners (OHPs), who are often among the first in the position to recognise signs of abuse and neglect due to their frequent interactions with children in dental settings. The Dental Council of New Zealand sets professional requirements, highlighting practitioners’ roles in responding to potential signs of maltreatment. Multiple statutes, including the Oranga Tamariki Act 1989 and the Family Violence Act 2018, govern OHPs’ responses. Despite this, there is a notable gap in OHPs’ confidence and understanding of their child protection roles, underlining the need for clear guidance on the legal and professional requirements that inform their responsibilities. This paper critically examines the professional responsibilities and policies governing OHPs in Aotearoa New Zealand regarding child protection responses. It also proposes the development of equity-focused guidelines, that are informed by Te Tiriti o Waitangi, emphasising culturally responsive practices, collaborations with Māori health providers and clear protocols for child protection responses.
“Waiting for Someone to Ask”: Successful Implementation of an IPV Response by Bicultural Settlement Staff with Refugee Women in Australia
(Informa UK Limited, 2025-09-01) Cameron, J; Spence, N; Spangaro, J; Toole-Anstey, C; Hegarty, K; Koziol-McLain, Jane; Zwi, A; Walsh, J; McMahon, T; Perry-Indermaur, A
Refugee women are less likely to seek support for intimate partner violence (IPV). This study examined an IPV intervention by bicultural settlement staff in Australia, aiming to enhance the capacity of settlement services to address IPV. The Safety and Health After Arrival (SAHAR) study was conducted in five settlement services in New South Wales. Bicultural caseworkers were trained to use the ACTS IPV screening tool and follow-up protocol, translated into several languages. Data were collected through focus groups (24 caseworkers, 4 IPV specialists) and interviews (5 managers). Seven themes emerged: (1) Confidence grew rapidly; (2) Clear and simple tools matter; (3) Language matching facilitates connection; (4) Settlement services can do this; (5) Disclosing is more complex for refugee women; (6) Care and inclusivity enable disclosure and help-seeking; (7) Women choose different pathways. Culturally tailored interventions and bicultural workers are crucial for supporting IPV disclosure and response. Implementing IPV screening in settlement services is feasible, increasing IPV awareness and providing disclosure opportunities. Ongoing training, support, and further research on long-term sustainability are needed.
Exploring Child Abuse and Neglect Responses: Qualitative Insights From Oral Health Practitioners in Aotearoa New Zealand
(Elsevier BV, 2025-08-28) Han, H; Koziol-McLain, Jane; Carrington, SD; Lees, Amanda B; Morse, Z
Background: Child abuse and neglect (CAN) remain significant concerns in Aotearoa New Zealand (NZ), with persistent inequities affecting indigenous Māori communities. Oral health practitioners (OHPs) are uniquely positioned to support CAN prevention and response through regular interactions with children via national dental care programs. Objective: To explore the experiences and perspectives of OHPs in CAN prevention, identification, and response, and identify actionable strategies to enhance their responsiveness across dental settings. Participants and setting: Twenty-one OHPs, including oral health therapists, dental therapists, dentists, dental specialists, and community oral health service managers, were recruited from diverse geographic regions and dental settings, including community clinics, private practices and school-based clinics. Methods: A qualitative design was used, involving twelve semi-structured interviews and two focus groups conducted between August 2023 and August 2024. Reflective thematic analysis was conducted to ensure a deep, contextual understanding of participants' insights. Results: Four themes were generated: opportunities to build relationships with families, needs for cultural and systemic awareness, collaborative approaches to child protection, and creating safer and more supportive practice environments. Two sub-themes emphasized the need for context-specific and straightforward guidelines and active workforce development in child protection. Conclusions: OHPs' responses to CAN varied depending on access to training, organizational support, and contextual factors. Enhancing culturally safe, interdisciplinary training and establishing accessible, practical guidance are key strategies to support OHPs' protective role. Policy reform should prioritize these supports to ensure better outcomes for children and their families.
Capturing the Emergence of Change in Complex Systems: The ‘Atawhai’ Study in Aotearoa, New Zealand
(SAGE Publications, 2025-03-23) Gear, Claire; Koziol-McLain, Jane; Eppel, Elizabeth; Hape, Hazel; Rolleston, Anna; Manuel, Carey; Timutimu, Ngareta; Ahomiro, Hori; Healy, Clare; Isham, Claire
A wide range of evaluative evidence is necessary to capture change within complex systems as findings shape the form and interpretation of outcomes, how they are valued, and actions moving forward. The Atawhai study worked with primary health care professionals in a series of workshops to distil ways to make it easier to respond to family violence as a key determinant of ill health. This article describes three methods used to evaluate the emergence of change from the perspective of the Atawhai research participants including pre/post-readiness surveys, social network analysis and qualitative exit interviews. Each method provides a unique perspective on the complexity involved and triangulation across the methods indicates validation of findings. Capturing change within complex systems requires methodological agility and overlaying of diverse evidence. The contribution of ‘soft infrastructure’ in developing and sustaining complex interventions should not be underestimated.
Screening for Coercive Control With Refugee Women Accessing Settlement Services
(Springer Science and Business Media LLC, 2025-05-08) Spence, N; Spangaro, J; Cameron, J; Hegarty, K; Hasan, H; Koziol-McLain, Jane; McMahon, T; Walsh, J; Zwi, A
Background: Coercive control is gaining increasing recognition as a form of intimate partner violence (IPV). Refugee women in countries of settlement are vulnerable to experiencing controlling behaviour. Interventions that support identification of controlling behaviour are an important step in enabling help-seeking for refugee women and prevention of further violence. Methods: The Safety and Health After Arrival (SAHAR) study tested a culturally tailored IPV screening and response strategy for refugee women accessing Australian settlement services. All women accessing the study sites were asked about controlling behaviours using the ACTS screening tool, which also asks about actions causing fear, threats, and physical abuse. Findings reported here include consultations with a lived experience panel and services, screening results, focus group data and manager interviews. Results: Of 312 women asked the ACTS questions by caseworkers in four settlement services, 90 women (29%) gave responses indicating IPV with controlling behaviour being the most frequently reported (78/90). Qualitative data indicate that, following consideration of language and diverse understandings of controlling behaviour, settlement service caseworkers were able to identify experiences of harmful forms of control. Conversations about control between caseworkers and women were prompted, and awareness about non-physical coercion increased. Conclusion: Despite challenges due to differences in language, interpretation and cultural norms, this study found it feasible to enquire about controlling behaviour with refugee women accessing settlement services, along with other forms of IPV.
Intimate Partner Violence and Post-Migration Stressors Reported by Refugee Women Accessing Settlement Services
(Springer Science and Business Media LLC, 2025-04-09) Spangaro, Jo; Spence, Nigel; Man, Nicola; Walsh, Jeannette; Cameron, Jacqui; Hegarty, Kelsey; Koziol-McLain, Jane; McMahon, Tadgh; Zwi, Anthony; Toole-Anstey, Chye; Perry-Indermau, Astrid
Intimate partner violence (IPV) is highly prevalent globally, with increased risk for women in situations of conflict, post conflict and resettlement. The Safety and Health after Arrival (SAHAR) study tested IPV screening with women accessing settlement services in New South Wales, Australia, using the validated ACTS tool, along with brief response involving risk assessment, safety planning and referral. A three month follow-up telephone survey was administered to women who had attended four participating sites which delivered the intervention. The survey explored the nature of any IPV experienced, factors associated with disclosure, and responses provided to those who identified IPV. Data is reported on 316 women of whom 48 (15%) identified current IPV. For 45 women who responded to Composite Abuse Scale items, the most common forms of abuse were forced isolation from family/friends (56% 25/45), blame for abusive behaviour (53% 24/45), "put downs" (44% 20/45) and physical violence 38% (17/45). Psychological distress and post-migration stressors were significantly higher for women who disclosed IPV compared to those who did not. Length of residency in Australia and whether the screening occurred during the first or subsequent service visits, were not associated with the likelihood of disclosing IPV. The majority of women who disclosed reported the caseworker's response to be helpful and involved risk assessment, safety planning and referral. Screening and response to disclosure in settlement services provide opportunities to address abuse experienced by this group of women who are less likely to report experiences of abuse or use mainstream services.
Te Aorerekura: Towards Eliminating Family Violence – Reflections from the Atawhai Project
(Victoria University of Wellington Library, 2025-02-17) Eppel, Elizabeth; Gear, Claire; Hape, Hazel; Koziol-McLain, Jane; Rolleston, Anna; Timutimu, Ngareta; Ahomiro, Hori; Healy, Clare; Hegarty, Kelsey; Isham, Claire
Family violence is an under-recognised contributor to ill-health. Atawhai, a three-year research project focusing on sustainable responses to family violence in primary healthcare services, suggests that relationships and networks among locality-based service providers and local communities will help in making New Zealand’s strategy to eliminate family violence a reality. More is needed than joining up the government agencies delivering services to those experiencing family violence. Building relationships between communities and healthcare providers to harness the contextual and cultural knowledge of those most affected has to be integral to a sustainable response that begins to address the causes of this wicked problem, along with developing place-based solutions.
Enhancing Child Protection Responses in Oral Health Practice: A Scoping Review of Evidence-Based Approaches
(Wiley, 2024-10-31) Han, Heuiwon; Koziol‐McLain, Jane; Morse, Zac; Lees, Amanda B; Carrington, Samuel D
Child abuse and neglect represent significant global health challenges with long‐lasting adverse impacts. Oral health practitioners, who often interact with children, play a key role in detecting and responding to suspected cases. Despite this, there is a notable gap in the systematic child protection measures in dental practices globally. This scoping review, utilising the Joanna Briggs Institute methodology, aims to outline current approaches for oral health practitioners and identify gaps in the approaches designed to enhance their responsiveness. Covering studies from January 2000 to May 2023, the review explored educational programmes, guidelines and interdisciplinary training modules. A comprehensive search across multiple databases, including MEDLINE, CINAHL and Scopus, along with grey literature sources, identified 1230 sources, resulting in the inclusion of 20 relevant sources. Findings highlight three main approaches: dental‐specific education programmes, practical guidelines for child protection responses and analysis of legal and professional obligations. These approaches demonstrate a mix of direct educational interventions and policy‐driven strategies aimed at enhancing oral health practitioners' knowledge, attitudes and practices towards child abuse and neglect. Given the identified variability and gaps in training and resources, future research should assess the effectiveness of these approaches and develop comprehensive, culturally safe training for oral health practitioners globally.
‘Atawhai’: A Primary Care Provider-Led Response to Family Violence in Aotearoa New Zealand
(Springer Science and Business Media LLC, 2024-05-17) Gear, Claire; Koziol-McLain, Jane; Eppel, Elizabeth; Rolleston, Anna; Timutimu, Ngareta; Ahomiro, Hori; Kelly, Eunice; Healy, Clare; Isham, Claire
Background As a key determinant of ill-health, family violence is inadequately responded to within Aotearoa New Zealand health policy and practice. Without adequate system support, health professionals can often be unsure of what to do, or how to help. Developed in response to this system gap, ‘Atawhai’ aims to make it easier for primary care professionals to respond to family violence. Methods Underpinned by indigenous Māori customs, Atawhai combines complexity theory and participatory research methodologies to be responsive to the complexity involved in family violence. We worked with 14 primary care professionals across ten whakawhitiwhiti kōrero wānanga (meetings for deliberate dialogue) to identify and develop primary care system pathways and tools for responding to family violence. This paper focuses on the development of Atawhai through wānanga and observation methods. Methods used to capture change will be reported separately. Findings Atawhai is a relational response to family violence, focused on developing a network of trusted relationships between health and social care professionals to support safe responses to those accessing care. This study identified four key health system pathways to responsiveness and developed associated tools to support health care responsiveness to family violence. We found the quality of relationships, both among professionals and with those accessing care, coupled with critical reflection on the systems and structures that shape policy and practice are essential in generating change within primary care settings. Conclusions Atawhai is a unique health care response to family violence evidenced on empirical knowledge of primary care professionals. Our theoretical lens calls attention to parts of the system often obscured by current health care responses to family violence. Atawhai presents an opportunity to develop a grassroots-informed, long-term response to family violence that evolves in response to needs.
Current Approaches Addressing Oral Health Practitioners’ Responsiveness to Child Abuse and Neglect: A Scoping Review Protocol
(Public Library of Science (PLoS), 2024-02-08) Han, Heuiwon; Koziol-McLain, Jane; Morse, Zac; Lees, Amanda B
Introduction: Child abuse and neglect (CAN) poses significant risks, causing severe and long-lasting effects on a child’s well-being, including physical and mental health and learning and socializing capabilities. Oral health practitioners (OHPs) uniquely position themselves to identify signs of maltreatment in the orofacial area, offer appropriate support, and collaborate with a multidisciplinary team. The literature has shown that OHPs under-report child protection concerns to a statutory child protection agency. Responding to CAN is often hindered by various factors, such as the fear of making false accusations and insufficient knowledge to detect and report potential cases. However, the literature lacks a comprehensive understanding of the strategies and interventions that can address the responsiveness of OHPs and other professionals to child protection issues. This scoping review aims to provide a broad overview and map the literature on the existing approaches to enhance the responsiveness of OHPs in child protection. Materials and methods: The proposed scoping review will be conducted following the JBI methodology for scoping reviews guideline and reported using the PRISMA-ScR guideline. The first exploratory search is conducted to refine the search strategy and inclusion and exclusion criteria. The second search will include MEDLINE (EBSCO), CINAHL (EBSCO), Dentistry & Oral Science Source (EBSCO), Cochrane Library, and Scopus, with a date range from January 2000 to March 2023. The third search will involve reference list searching and gray literature searching in Google and Google Scholar. Government and international health organizations’ websites will be searched for policies and guidelines. The review will consider studies that report the current approaches to address OHPs’ responsiveness to CAN in any setting. Two reviewers will independently select sources and extract data. Any disagreements will be resolved by consensus of the research team. The extracted data will be presented in a tabulated chart with a narrative summary.
Child Abuse Knowledge and Attitudes Among Dental and Oral Health Therapists in Aotearoa New Zealand: A Cross-Sectional Study
(BioMed Central, 2023-07-27) Han, Heuiwon; Lees, Amanda; Koziol-McLain, Jane
Background Child abuse and neglect are significant social and health issues in New Zealand. As the government provides free oral care to children and adolescents, oral health practitioners are positioned to respond to child protection concerns. However, research on the knowledge and attitudes of oral health practitioners is limited. This study aimed to understand the knowledge and attitudes of New Zealand dental and oral health therapists in detecting and reporting child abuse and neglect. Methods In this descriptive exploratory cross-sectional study, we invited registered New Zealand dental and oral health therapists treating children and adolescents to the anonymous online survey. Results Among the 92 dental and oral health therapists, 72% agreed that they could recognise the signs and symptoms of child abuse and neglect. Yet, only 48% agreed they were familiar with the reporting process. During their professional careers, 62% had at least 1 suspected case; and only 21% had ever reported their concerns. Fear of false reporting (70%) was the most significant barrier. Conclusions Participants understood child abuse and neglect as significant social issues; however, the knowledge and attitudes to respond were limited. Efforts to enhance the knowledge and attitudes will be necessary to promote child safety and wellbeing.
Understanding Workplace Violence Against Medical Staff in China: A Retrospective Review of Publicly Available Reports
(Springer Science and Business Media LLC, 2023-06-20) He, Yumei; Holroyd, Eleanor; Koziol-McLain, Jane
BACKGROUND: Workplace violence against medical staff in China is a widespread problem that has negative impacts on medical service delivery. The study aimed to contribute to the prevention of workplace violence against medical staff in China by identifying patterns of workplace violence, key risk factors, and the interplay of risk factors that result in workplace violence. METHODS: Ninety-seven publicly reported Chinese healthcare violent incidents from late 2013 to 2017 were retrospectively collected from the internet and analysed using content analysis. A modified socio-ecological model guided analysis of the violent incidents focusing on risk. RESULTS: Physical violence, yinao, or a combination of physical and verbal violence were the typical forms of violence reported. The findings identified risk at all levels. Individual level risk factors included service users' unreasonable expectations, limited health literacy, mistrust towards medical staff, and inadequacy of medical staff's communication during the medical encounter. Organisational level risk factors under the purview of hospital management included problems with job design and service provision system, inadequacies with environmental design, security measures, and violence response mechanisms within hospitals. Societal level risk factors included lack of established medical dispute-handling mechanisms, problems in legislation, lack of trust and basic health literacy among service users. Situational level risks were contingent on risk factors on the other levels: individual, organisational, and societal. CONCLUSIONS: Interventions at individual, situational, organisational, and societal levels are needed to systematically address workplace violence against medical staff in China. Specifically, improving health literacy can empower patients, increase trust in medical staff and lead to more positive user experiences. Organizational-level interventions include improving human resource management and service delivery systems, as well as providing training on de-escalation and violence response for medical staff. Addressing risks at the societal level through legislative changes and health reforms is also necessary to ensure medical staff safety and improve medical care in China.
Integrated System Responses for Families Impacted by Violence: A Scoping Review Protocol
(BMJ Journals, 2021-11-16) Gear, Claire; Ting, Chien Ju; Eraki, M; Eppel, E; Koziol-McLain, Jane
Introduction: The impacts of violence have a significant effect on health and well-being, particularly for women and children. Violence within families is widely recognised as a complex problem constituted by constantly interacting and evolving social, economic, health and cultural elements. Calls for integrated services have arisen from growing understanding about the implications of this complexity, which suggest family violence and solutions to it are generated endogenously from the reflexive nonlinear interactions of system agents. Despite these calls for integration, services designed to support families impacted by violence and the systems that design and fund them are often responsive only to one part of the problem and might not pay attention to agent interactions and their adaptive reflexivity. This paper outlines a scoping protocol to explore how integrated approaches to family violence are conceptualised in current literature, with innovative use of a complexity theory lens. Method: Our scoping review protocol follows the framework outlined by Arksey and O’Malley and refined by Levac. It searches 6 databases, 3 journals and 10 websites using keywords to capture the notion of integration and a complex adaptive system, namely the participant (system agents), concept (system agent interaction) and the context (family violence). Selection criteria require the articles to be written in English, have full-text article available, and were published after 2010. Items selected also need to be evidence based showing interaction between system agents. Applying complexity theory, sensitises us to the reflexive patterns of interaction between system elements and routine ways of interacting. Ethics and dissemination: The nature of this review means that ethics approval is not required. Findings will be disseminated via academic publications, conferences and discussions with policy decision-makers. The findings will be used to develop a plan for stakeholder consultation to share and validate learnings and inform future research.
Impact of COVID-19 on the Health Response to Family Violence in Aotearoa New Zealand: A Qualitative Study
(SAGE Publishing, 2023-01-29) Koziol-McLain, Jane; Cowley, C; Nayar, S; Koti, D
COVID-19 pandemic planning and response has resulted in unprecedented upheaval within health systems internationally. With a concern for increasing frequency and escalation of family violence, the so called “shadow pandemic,” we wondered how health system violence intervention programs were operating during this time. In Aotearoa New Zealand, the Ministry of Health Violence Intervention Program (VIP), using a systems approach, seeks to reduce and prevent the health impacts of family violence and abuse through early identification, assessment, and referral of victims presenting to designated health services. In this qualitative descriptive study, we explored how the VIP program was impacted during the first year of the COVID-19 pandemic. Forty-one VIP coordinators and managers representing 15 of the 20 New Zealand District Health Boards and the National VIP Team participated. Across 12 focus groups (8 face to face and 4 via Zoom) and 7 individual interviews (all via Zoom) participants shared their experience navigating systems to support frontline health providers’ responsiveness to people impacted by family violence during the pandemic. In our reflexive thematic analysis, we generated 3 themes: Responding to the moment, valuing relationships, and reflecting on the status quo. Our findings demonstrate the dynamic environment in which participants found creative ways to adapt to the uncertainty and engage with communities to re-shape interventions and ensure continued implementation of the program. At the same time, challenges within the system prior to the pandemic were brought into view and highlighted the need for action. These included, for example, the need for improved engagement with Māori (Indigenous people of Aotearoa New Zealand) to address long-standing health inequities. Having quality essential services for those impacted by family violence that engages with local knowledge and networks and routinely copes with uncertainty will strengthen our systems to minimize risk of harm during emergencies.
Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial
(JMIR Publications, 2021)
BACKGROUND: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or whānau (indigenous Māori extended family networks), to learn how to offer better support to taitamariki. OBJECTIVE: The aim of our taitamariki- and Māori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). METHODS: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the Māori subgroup. RESULTS: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). CONCLUSIONS: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous Māori-centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/24792.

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